Cost-Effectiveness of a Serum Biomarker Test for Risk-Stratified Liver Ultrasound Screening for Hepatocellular Carcinoma

Oct 1, 2021, 00:00 AM
10.1016/j.jval.2021.04.1286
https://www.valueinhealthjournal.com/article/S1098-3015(21)01541-2/fulltext
Section Title : ECONOMIC EVALUATION
Section Order : 1454
First Page : 1454

Objectives

Risk-stratified ultrasound screening for hepatocellular carcinoma (HCC), informed by a serum biomarker test, enables resources to be targeted to patients at the highest risk of developing cancer. We aimed to investigate the cost-effectiveness of risk-stratified screening for HCC in the Australian healthcare system.

Methods

A Markov cohort model was constructed to test 3 scenarios for patients with compensated cirrhosis: (1) risk-stratified screening for high-risk patients, (2) all-inclusive screening, and (3) no formal screening. Probabilistic sensitivity analyses were undertaken to determine the impact of uncertainty. Scenario analyses were used to assess cost-effectiveness in Australia’s Aboriginal and Torres Strait Islander peoples and to determine the impact of including productivity-related costs of mortality.

Results

Both risk-stratified screening and all-inclusive screening programs were cost-effective compared with no formal screening, with incremental cost-effectiveness ratios of A$39 045 and A$23 090 per quality-adjusted life-year (QALY), respectively. All-inclusive screening had an incremental cost-effectiveness ratio of A$4453 compared with risk-stratified screening and had the highest probability of being cost-effective at a willingness-to-pay (WTP) threshold of A$50 000 per QALY. Risk-stratified screening had the highest likelihood of cost-effectiveness when the WTP was between A$25 000 and A$35 000 per QALY. Cost-effectiveness results were further strengthened when applied to an Aboriginal and Torres Strait Islander cohort and when productivity costs were included.

Conclusions

Cirrhosis population-wide screening for HCC is likely to be cost-effective in Australia. Risk-stratified screening using a serum biomarker test may be cost-effective at lower WTP thresholds.

https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)01541-2&doi=10.1016/j.jval.2021.04.1286
HEOR Topics :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Methodological & Statistical Research
  • Modeling and simulation
  • Oncology
  • Specific Diseases & Conditions
Tags :
  • cirrhosis
  • cost-utility
  • economic evaluation
  • liver cancer
  • Markov model
Regions :
  • Asia Pacific (including Oceania)